BJSM

Do you consider the first 10 seconds of a consultation to be important? Have you looked at your clinic space and how that might affect your patients? In this podcast Steve Aspinall (BASRaT) speaks to Richmond Stace @painphysio about the importance of compassion and active listening in the treatment of pain.

Richmond is presenting at the BASRaT symposium on the 18th of November in London.

Our Symposium this year will focus on pain; with unmissable keynote speeches from experts in the field and presentations and workshops that will enrich your knowledge.

Focussing exclusively on pain and all its forms and manifestations it will be vital for practitioners to help manage and manipulate pain and help people from all walks of life.

Our unmissable range of speakers includes Richmond Stace who is leading advances in understanding and treating pain and has created the pain coach programme.

Richmond will look into the importance of the first point of contact, how we can gain information from the first few words.

We have a range of workshops including "Gold from Rio"- BASRaT Sport Rehabilitator, Hannah Crowley helped Ed Clancy on his road to recovery from a back injury and to his gold medal win at Rio.

Our closing keynote "Pain, the Brain and a little bit of Magic" will be presented by Professor Anthony Jones. Professor Jones is an MSK pain specialist and leads the Human Pain Research Group.

This one day event on Friday 18th November will be packed full of essential speeches, presentations and seminars, enriching your knowledge and aiding your work.

BOOK NOW. Visit basrat.eventbrite.co.uk.

Timeline:

1:03 How big is the problem of pain?

2:39 What does good communication mean?

8:00 What are the key points in an interview about pain?

12:11 How to pain the patients journey?

16:44 Is neuroscience education important?

18:59 Key messages for the clinician

Links:

http://basrat.org/

http://www.eventbrite.co.uk/o/british-association-of-sport-rehabilitators-and-trainers-6930299875

Over the last 20 years across the western world the increasing toll of sedentary behaviour on young peoples physical and mental wellbeing is a well-documented phenomenon. Many different piecemeal policy initiatives have failed to tackle the problem. In this podcast Steve Aspinall (BASRAT) speaks to head teacher Elaine Wyllie about the daily mile initiative. This simple game changing initiative provides massive public health benefits though a simple philosophy of non-competitive outdoor fun that is accessible to all children regardless of age, gender, ability or socioeconomic background.

Listen to Steve and Elaine discuss this inspirational initiative and find out how you can get involved:

Timeline:

1:03 What is the daily mile?

1:49 How is the daily mile implemented in schools what are examples of best practice?

4:54 Does the daily mile work for all children?

8:56 How does the weather impact participation?

11:43 Local and national level support

15:04 Preliminary results of a large scale study

17:00 How to get involved

Links:

http://thedailymile.co.uk/

http://basrat.org/

http://www.eventbrite.co.uk/o/british-association-of-sport-rehabilitators-and-trainers-6930299875

Rugby is often maligned in the press for its inevitable relationship with concussion, with numerous high-profile incidents only compounding the issue. If your reading is restricted to the newspapers, you’d be forgiven for thinking that a culture of denial is in place, however when you delve deeper, there are numerous examples of innovative and powerful research, all of which is already leading to law & policy changes. One leading light in the sport is the Rugby Football Union (RFU), who are actively conducting policy-informing research, and using this to shape the game in order to maximise player welfare. Steffan Griffin, of the BJSM, caught up with Dr Simon Kemp (CMO), Dr Matt Cross (Professional Rugby Medical Research Officer), and Dr Mike England (RFU’s Community Rugby Medical Director), who provide an insight into their work, which is not only shaping the way the game is played, but provides a fantastic blueprint for other sports to follow. This is Part 1: in the build up to the Berlin Consensus Conference.

Timeline:

01:15: Can you give us some insight into the scale of concussion in Rugby Union?

04:00: Are the rising rates due to increased incidence or due to people being more likely to recognise and report it nowadays?

06:45: What is the RFU’s general approach to the management of Concussion?

08:45: Can you tell us a little about the ‘recognise, remove, recover and return’ campaign?

14:00: So the aim is to remove as many concussed players from the pitch as soon as possible: what else is the RFU doing to try and ensure this?

19:15: you have published a number of papers in the BJSM – one of which showed a relationship between concussion and subsequent musculoskeletal injuries – could you please elaborate?

21:50: What does this mean about the return to sport following concussion? How could this influence practice?

Links

Evaluation of World Rugby's concussion management process: results from Rugby World Cup 2015 http://bjsm.bmj.com/content/early/2016/09/01/bjsports-2016-096461.abstract

The accuracy and reproducibility of video assessment in the pitch-side management of concussion in elite rugby http://www.jsams.org/article/S1440-2440(16)30142-6/abstract

Professional Rugby Union players have a 60% greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes http://bjsm.bmj.com/content/early/2015/12/01/bjsports-2015-094982.full

BJSM Podcast with the Heath Brothers & Mike Evans: https://soundcloud.com/bmjpodcasts/23-5-hours-to-switch-behaviour?in=bmjpodcasts/sets/bjsm-1

Phil Glasgow is the head of sports medicine at the Sports Institute, Northern Ireland. A vastly experienced physiotherapist, he has worked at 3 Olympic Games, and has just returned from Rio. In this podcast, we discuss a case history of a football player with hip pain, from assessment to RTP. We look at the sensitivity vs. specificity of various tests, how to explain the symptoms to patients, and any co-existing pathologies there may be in the athlete. Finally, the discussion moves to treatment, the role of manual therapy, and exercises the patients can do to increase strength in the tissue.

The 2nd World Conference of Sports Physiotherapy will be held in Belfast, 2017- details can be found here: http://bit.ly/2dP2HjH

Timeline

0.40 - Hip pain: a case history and when is it reported to the physio?

3.08 - Ruling things out in the hip is easy: how do we rule things in?

7.30 - Things to consider when treating the hip

10.30 - Prescribing exercise for the patient - how do we go about it?

13.00 - How to increase the load in the injured athlete

18.26 - Bridging exercises for the hip

22.50 - Building a model for the pain and tips from the top

“A few years ago, like most doctors, I was pretty ignorant on the topic of food and medicine” is how Peter Brukner, Professor at Latrobe University’s Sport and Exercise Medicine Research Centre opens this podcast. He summarises 4 years of engaging seriously with nutrition for health and in sport. His comments apply to the general public, the recreational athlete and he shares his experience from elite level sport. Peter has been involved in an international nutrition educational leadership group that includes Professor Timothy Noakes, Dr Aseem Malhotra, Dr Sarah Hallberg, Dr Jason Fung, Nina Teicholz and Gary Taubes. Recent reports that the sugar industry paid two Harvard professors to write a piece for the New England Journal of Medicine https://www.statnews.com/2016/09/12/sugar-industry-harvard-research/ makes the opinion of unbiased academic clinicians like Peter Brukner even more timely.

Relevant links:

Peter Brukner on the other side of the mike interviewing Professor Timothy Noakes: https://soundcloud.com/bmjpodcasts/high-fat-for-health

Dr Jason Fung on the impact of diet on obesity and type 2 diabetes mellitus: https://soundcloud.com/bmjpodcasts/dr-jason-fung-on-the-impact-of-diet-on-obesity-and-type-2-diabetes-mellitus

Prof Stephen Phinney on the science behind low carb diets for athletes: A rational approach:

https://soundcloud.com/bmjpodcasts/prof-stephen-phinney-on-the-science-behind-low-carb-diets-for-athletes-a-rational-approach?in=bmjpodcasts/sets/bjsm-1

If you think that BJSM is only sharing one side of the story please use our various channels to contribute. Papers, blogs, podcasts, Twitter, Facebook - we’d love to hear from you. We haven’t rejected any papers saying that hi-carb is good for you!

Dr Kieran O’Sullivan, PT, PhD, was one of the first podcast guests to crack 9,000 listens! From the University of Limerick, Ireland, he has vast clinical experience and he completed a PhD on the role of sitting in back pain. In this 18-minute podcast he reviews his 2015 podcast in the first 3 minutes and then rattles off at least 7 practical tips.

Kieran was a guest of PhysioFirst (UK) when BJSM interviewed him in April 2015. The 2017 PhysioFirst conference is on April 1-2 (2017!) in Nottingham (UK) and guest speakers include Professor Paul Hodges, Dr Tania Pizzari and Dr Igor Tak.

Timeline:

1.00 m Back pain is neither explained by what patients and clinicians see on scans nor just by load

2.00 m When treating, you need to assess the various factors that could be playing a role, such as load, posture, stress, and address the right one.

4.00 m Should we try to prevent all back pain? Listen to Dr O’Sullivan challenge the belief that it’s important to never have back pain. He likens back pain to conditions like sadness, constipation – not great but not a major problem as long as it doesn’t persist. Athletes need to load their bodies and adapt rather than avoid load and become vulnerable (See Gabbett papers and podcast, below). Don’t pass on fear (of back pain coming on or persisting) to athletes.

5.00 m Screen for red flags of course, if the clinical picture warrants it – but most long-term back pain is NOT due to something listed as a red flag.

6.00 m Reassurance – being empathetic without inducing fear.

7.00 m Think through. What precipitated the pain? Too much load, too much stress, bad posture, movement patterns? If unknown, have patient create a pain diary. Look for trends. Examine all the dimensions of the biopsychosocial model.

9:00 m Don’t just make the diagnosis but be practical. Patient sad? Don’t just say ‘You are sad, your back pain will go away’. Provide specific treatment for the specific threat.

10:00 m Empower the patient to choose the exercises he or she wants and what he or she will do! Exercise has benefits across systems.

11:00 m Don’t give up. Here Kieran walks us through a challenging real life case. A simple tissue diagnosis would not have helped this person at the centre of the case

12:00 m Explain! Explain the pain! (HT to Professor Lorimer Moseley and Dr David Butler).

13:00 m The period at 4-6 weeks of pain can be difficult – patient has not adapted to the contemporary model and may still be on waiting list for imaging.

14:00 m What is the evidence for this approach? How does the evidence compare, with, for example Hamstring injuries?

Links to previous podcast:

2015 – Dr O’Sullivan on “Effective treatments for back pain: Kieran O'Sullivan’s practical tips within a guiding framework” http://ow.ly/4nepGu

BJSM paper:

O'Sullivan K, O'Sullivan P. The ineffectiveness of paracetamol for spinal pain provides opportunities to better manage low back pain. Br J Sports Med. 2016 Feb;50(4):197-8. http://ow.ly/4neqbS (Members Only/subscribers)

Manual Therapy paper:

Hurley J, …., O'Sullivan K. Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials. Man Ther. 2016 Mar 10. pii: S1356-689X(16)00017-5. doi: 10.1016/j.math.2016.02.009. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/27026111

Do you treat patients with neck pain? Do you have neck pain? Stop reading and start listening to the podcast. Professor Gwen Jull is one of the most lauded health professionals in the world right now and she shares pearls every minute of this podcast.

Here's the link to the second part of the podcast: https://soundcloud.com/bmjpodcasts/managing-cervicogenic-headache-and-other-pearls-professor-gwen-jull-second-of-two-podcasts?in=bmjpodcasts/sets/bjsm-1

Timeline

0:00m - How do you approach the patient aged in the prime of life who complains of neck pain and bad cervical posture?

2:00m - “Big development in physiotherapy is the assessment /examination which then forms the basis of our treatment” - movement and also how the movement is performed. Facet joint tests, muscle coordination.

3:10m - Detailed specific assessment of posture in the patient with neck pain. Have the patient adopt the work positions. Aim to correct the posture to see if pain changes.

5:10m - How to distinguish the superficial and deep neck extensors

8:30m - 3 trajectories in whiplash patients; folks who get better fairly rapidly (50%), those who suffer persistent mild pain (> 2years, 30%), and ‘the major worry’ of those who have persistent moderate to high levels of pain for many months and sometimes going on for years. What predicts these trajectories? “The last group is a real stumbling block for all professions”.

11:00m - Predictors of the poor outcomes.

12:00m - See the link to the Jull and Sterling booklet for patients - ow.ly/Soyma.

13:00m - Treatment of a patient with uncomplicated whiplash - “Hurry slowly”.

14:00m - Contribution of post-traumatic stress disorder

14:30m - Management of the complicated case of whiplash. Multiprofessional approach. Multimodal care. Instruments to assess severity and to look for particular elements.

16:20m - Providing overall management of the patient. Avoiding the medical merry-go-round

17:00m - Exercise is important (this will appeal to you Adam!)!

17:30m - “My emphasis is on treating multimodally”

18:00m - Manual therapy in the context of multimodal programme

19:00m - Explaining imaging findings to the patient

19:33m - Trigger points and dry needling?

Remember the 2nd part of this conversation (about Headache and more) will be available on the BJSM podcast site on 2nd October, 2015.

Links:

Grieve’s Modern Manual Physiotherapy (4th edition): Book review here http://ow.ly/Sj4cn Gwen Jill is the lead author of this physiotherapy bible

Related podcast: Professor Michele Sterling: ‘Managing Whiplash’ (2013). Very practical management of Whiplash that held up over the 2 years. http://ow.ly/Sj4Jz

Is the neck pain related to concussion? A related paper in BJSM: Schneider KJ, et al. Br J Sports Med. 2014 Sep;48(17):1294-8. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial.

http://bjsm.bmj.com/content/48/17/1294.abstract

Do you want to get your athletes with an acute hamstring injury back to play as quickly as possible, without the risk of a recurrence? Should you include lengthening exercises, trunk stabilisation, Nordic curls or PRP injections? Are you searching for a comprehensive, evidence-based update?

This 10-minute podcast will answer all your questions. BOOM!

Eminent sports physician Johannes Tol asks the hard questions. Sports physician Haiko Pas provides answers based on his recent systematic review & meta-analysis on hamstring rehab programs and PRP injections.

Time codes: Optimal treatment for a quick return to play (2.30 min), re-injury reduction (3.50min) and the added value of PRP injections (6.20min). The podcast finishes with three evidence based take home messages for the clinician dealing with acute hamstring injuries (8.20 min).

Links:

Pas H, Reurink G, Tol JL, Weir A, Winters M, Moen M. Br J Sports Med 2015 (BJSM issue 18)

Efficacy of rehabilitation (lengthening) exercises, platelet rich plasma injections and other conservative interventions in acute hamstring injuries: An updated systematic review and meta-analysis. http://bjsm.bmj.com/content/early/2015/07/21/bjsports-2015-094879.abstract

Brukner P.

Hamstring injuries: prevention and treatment—an update.

Br J Sports Med. 2015 Jun 23. pii: bjsports-2014-094427. doi: 10.1136/bjsports-2014-094427. [Epub ahead of print]

http://bjsm.bmj.com/content/early/2015/06/23/bjsports-2014-094427.long

Hamilton B, Tol JL, Almusa E, Boukarroum S, Eirale C, Farooq A, Whiteley R, Chalabi H.

Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial.

Br J Sports Med. 2015 Jul;49(14):943-50. doi: 10.1136/bjsports-2015-094603.

http://bjsm.bmj.com/content/49/14/943.long

Bahr R, Thorborg K, Ekstrand J.

Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey.

Br J Sports Med. 2015 May 20. pii: bjsports-2015-094826. doi: 10.1136/bjsports-2015-094826. [online first and issue 22]

http://bjsm.bmj.com/content/early/2015/05/20/bjsports-2015-094826.long

Reurink G, Goudswaard GJ, Moen MH, Weir A, Verhaar JA, Bierma-Zeinstra SM, Maas M, Tol JL; Dutch HIT-study Investigators.

Rationale, secondary outcome scores and 1-year follow-up of a randomised trial of platelet-rich plasma injections in acute hamstring muscle injury: the Dutch Hamstring Injection Therapy study.

Br J Sports Med. 2015 May 4. pii: bjsports-2014-094250. doi: 10.1136/bjsports-2014-094250. [Epub ahead of print]

http://bjsm.bmj.com/content/early/2015/05/03/bjsports-2014-094250.long

Dr David Opar joins us for this BJSM podcast. David is a lecturer at the Australian Catholic University in Melbourne and one of the emerging voices in the field of hamstring strain injuries, having done work on the possible mechanism of injury as well as prospective studies aimed at better understanding eccentric strength as a risk factor for these injuries.

His work also investigates the Nordic Hamstring Device, developed by the Queensland University of Technology Hamstring Group, looking into the potential of this device in prevention, treatment and rehabilitation of hamstring injuries.

Nicol van Dyk, a physiotherapist in the Rehabilitation Department at Aspetar Sports Medicine & Orthopaedic Hospital in Qatar, leads the discussion around nordic hamstring exercises, the role of eccentric strength in hamstring strain injuries and the seeing the big picture in prevention and rehabilitation.

With hamstring strain injuries continuing to receive much attention in the literature and mainstream media, David Opar elucidates some significant features of this common injury.

With over twenty years' experience, accreditation in Sports Physiotherapy, and a recent PhD in the topic of lateral hip pain, Alison Grimaldi (@AlisonGrimaldi) was invited to this podcast by BJSM’s Twitter community.

She is a popular conference speaker internationally. Here she walks you through each step of the assessment and treatment of an older patient with right hip pain. She then shares how to assess and treat a younger sportsperson.

In both cases, Dr Grimaldi emphasizes that compression is bad for tendons that run over bony prominences (trochanter in this case) and indicates how this can be addressed.

Enjoy one of our most practical podcasts. Recorded at the Physiotherapy New Zealand Conference, Auckland (September 2014) with thanks to the NZ Sports Physiotherapy Interest Group (@SportsPhysioNZ).

Links:

1) JL Cook, C Purdam Is compressive load a factor in the development of tendinopathy? Br J Sports Med 46(3):163-8. 2012 http://bjsm.bmj.com/content/46/3/163.abstract

2) Fearon A, Stephens S, Cook J, et al. The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. A case control morphology and anthropometric study. Br J Sports Med. 2012 http://bjsm.bmj.com/content/46/12/888.long